Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

July 18, 2016

Would I let a rough hygienist clean my teeth?


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Dr. Hall,
All of my top teeth (except the molars) have porcelain crowns. I was advised years ago not to have a Cavitron used to clean the crowns. I recently had my teeth cleaned by a new hygienist who became very upset when I asked her not to use the machine. She scaled my crowns with so much force that it was painful and I really worried she would break them. The 4 center teeth do not have a metal lining behind the porcelain and I treat them very carefully. Which is the lesser of two evils – the Cavitron or a brutal hygienist scaling my porcelain crowns with hand instruments? Could there really be that much plaque on a porcelain surface?
– Elizabeth from Massachusetts

Elizabeth,
I’m getting a lot of these Cavitron questions lately. I think that’s because their use is getting more popular with dental hygienists.

The Cavitron by itself won’t hurt your porcelain crowns or other porcelain restorations. See my earlier post on this: Is the Cavitron safe for use with porcelain veneers? We used to give a blanket prohibition against using the Cavitron with porcelain crowns or veneers, but our observation of the care being used by dental hygienists has caused us to soften that. Used properly, there is no risk of damage from the Cavitron to crowns or any other restorations.

What bothers me most about what you told me is that your hygienist became upset when you asked her not to use the Cavitron. I talked to my own hygienist about this Cavitron issue and she said she gets a number of requests from patients to not use the Cavitron in certain places, or other requests, and she honors those requests. This haughty attitude and lack of sensitivity to the patient is not good. It’s kind of like you are in the way of her doing her job. She doesn’t seem to connect that you are paying for her services. Hygienists and dentists get a number of special requests like this from patients, and I believe the proper response is to honor those when possible. Yes, you may have made more work for her, but serving the patient is her job.

To answer your question, yes, the hygienist can do damage even without the Cavitron. Heavy scaling can nick the margins. If I were in your position, I wouldn’t let this hygienist touch my teeth any more, whether she used a Cavitron or a hand scaler or a toothpick. If that meant switching dentists, I would do it, and let the dentist know the reason. From what you’ve told me, I have serious questions about how much she cares about her patients, which for me is the first requirement of quality care. In rough hands, a Cavitron can do significant damage not just to restorations but even sometimes to your teeth.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 14, 2016

Is the Cavitron safe for use with composite restorations?

Filed under: Dental Cleanings — Tags: , , , — mesasmiles @ 2:39 pm

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Greetings Dr. Hall:

My query is in relation to the Cavitron Ultrascaler for cleaning. I have a couple of class 5 restorations on my front teeth but am concerned that the metal tip of the Cavitron will damage the composite restoration. I am getting conflicting information online that the Cavitron will damage the composite and will not damage the composite, as long as a low power setting is used. Also, it is safe to use only if a plastic sleeve or carbon composite tip is used? I am confused. Given my particular circumstance, under what conditions is the Cavitron safe to use and not to use? I do thank you, sir, for your input and time on this concern of mine.

Cordially,
– Cara from Pennsylvania

Dear Cara,
The reason you’re getting conflicting answers in your online searches about the effect of a Cavitron on composite restorations is that there isn’t a straight answer to the question.

Yes, a Cavitron can damage porcelain veneers or composite restorations. A class V composite which is right at the gumline could be especially vulnerable. But it depends on the operator whether it actually will or not. I can help explain that with an analogy. I had a barber when I lived in Iowa who, every time I had him cut my hair, he would shave the back of my neck with a straight razor. Now that’s a nasty instrument and used improperly he could have really caused some damage. But he knew how to use it, and because of his skill I was more likely to cut myself with my own safety razor than be cut by him with his straight razor. That’s similar to the Cavitron issue.

I used to include Cavitron on my list of no-nos for people with porcelain veneers and other cosmetic dental work, but I don’t any more. That comes from my personal observation of three different dental hygienists who have used Cavitrons on me with great care and skill. If they’re smooth in their hand motions and light with their touch, they won’t cause a problem. If they’re not, they can damage more than restorations – they can nick and gouge the cementum on your teeth, giving you sensitive areas that attract plaque and calculus.

To give me a little more perspective, I asked my current hygienist, Courtney at Dr. Kelly’s office in Scottsdale, to comment on your question. She said that yes, a Cavitron can damage restorations if it is used improperly. The way she handles it is that she doesn’t use the very tip of the instrument on the restoration, and she is careful not to dwell on any restoration. She added that she has patients who will share with her that they feel uncomfortable with certain procedures and they will tell her they don’t want her using the Cavitron around certain restorations, for example, or they want her to thread the floss through their teeth in a certain way, and she honors those requests. Being her patient, I can say that I feel that the Cavitron is a safe instrument in her hands, and I let her go where she feels she needs to go with it.

What I would recommend, if you have any anxiety about this, is to ask your hygienist what he or she would do around class V composites. Listen to the explanation, and if you detect a level of confidence that reassures you, let them go ahead. If, after the explanation, you have any doubts, then ask them to stay away from those areas and they should respect that request.

Dr. Hall

Question and answer go here.

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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